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In Politics on Wednesday, 31 October 2012 at 13:42

Why Romney Would Be Good For Doctors

Harris Meyer

Some physicians who favor Romney say that he will bring positive changes for physicians and the practice of medicine:

Introduction

Mitt Romney’s healthcare approach would be better for America’s physicians because it would unleash free-market forces to let doctors deliver quality healthcare, give consumers more private insurance choices, and drive down costs in both private and public insurance programs, say many conservative physicians.

• Many physicians backing Romney ardently support his call for repealing President Obama’s Affordable Care Act (ACA), which they see as destructive to US healthcare.

• Doctors like Romney’s proposal to encourage individual ownership of health insurance by giving people an income tax deduction for premium payments.

• They favor his ideas for deregulating insurance by letting out-of-state insurers sell policies nationally without having to meet state benefits, and boosting high-deductible health plans by letting people pay premiums out of their tax-free health savings accounts.

• And they love that Romney wants to curb medical malpractice lawsuits and reduce defensive medicine by capping noneconomic damages.

These conservative doctors may represent the majority view of physicians. A randomized national survey of 3660 doctors in September 2012, conducted by healthcare staffing firm Jackson & Coker, headquartered in Alpharetta, Georgia, found that 55% of physicians said that they would vote for Romney while 36% would vote for Obama.[1] Male doctors, who comprised 72% of respondents, were far more likely to support Romney, while female doctors, who comprised 28%, were evenly split between the 2 candidates. The percentage who said that the ACA should be repealed and replaced was 55%, with 40% saying that it should be implemented and improved.

Romney supporters admit to some reservations because as Governor of Massachusetts, Romney passed a state healthcare reform law that served as the model for the federal law. Still, supporters say that, on balance, he would be far better than Obama for doctors.

Indeed, some conservatives admit that their presidential vote on November 6 will be as much anti-Obama as pro-Romney. “We have to repeal that monstrous law [the ACA],” says Robert Sewell, MD, a solo practice surgeon in Southlake, Texas, who represents the American Society of General Surgeons in the American Medical Association (AMA) House of Delegates. “I have to take Gov. Romney at his word that, if elected, he would do that. In that case I’m a supporter of his.”

Physicians Who Are Staunch Romney Supporters

Others are more ardent in their support for Romney. “Romney wants to restore the doctor-patient relationship and have healthcare decisions made by patients in conjunction with their doctor, not by a panel of government-appointed bureaucrats,” says Scott Atlas, MD, a Stanford University neuroradiologist and Hoover Institution senior health policy fellow who is advising the Romney campaign.

“He focuses on improving private insurance options rather than shifting millions of people into government insurance. That’s good, because doctors in general don’t want to practice in an environment where their hands are tied in how to diagnose and treat patients,” says Dr. Atlas.

They also much prefer Romney’s positions on taxes, deregulation, and the economy. While Obama proposes to end the Bush tax cuts on family incomes over $250,000 and says that wealthier Americans should pay more, Romney proposes to keep the Bush tax cut for higher incomes, maintain the lower capital gains rate, reduce income tax rates by 20% across the board, and eliminate the estate tax.

“Rich people are already paying the vast majority of taxes,” Dr. Sewell says. “Romney believes that the solution is to increase the number of people with jobs paying taxes. It should be a disgrace that 47% of people don’t pay federal income taxes.”

No Benefit From Redistributing Wealth

That’s echoed by Jane Orient, MD, a Tucson general internist and executive director of the Association of American Physicians and Surgeons, which promotes the private practice of medicine. “Romney believes in free enterprise and he doesn’t believe we can solve problems by redistributing wealth, which is what Obamacare is about. Obama believes we can make people better by taking from people who are successful. That’s totally destructive to the economy.”

Conservative physicians express confidence that Romney’s approach would give doctors greater freedom to practice medicine in the way they think is best for patients. They believe Obama’s healthcare law puts too much emphasis on trying to keep people healthy through preventive care at the expense of providing high-tech tests and treatments for sick people. They think that it favors primary care physicians over specialists. And they believe that it creates mechanisms that would tell doctors how to practice and limits access to state-of-the-art services.

“Obama’s plan shifts spending priorities from specialty care to generalist care, and that’s rolling back the clock to the 1950s and dumbing down healthcare,” Dr. Atlas contends. “All doctors know that the key to healthcare improvement has been more and more specialist care and more access to technology and innovative drugs.”

Dr. Orient says, “The Romney plan boils down to giving people more freedom and doing away with impediments put in place by intellectuals who think they know everything, and that if the federal government sets the rules then everything will be fine.”

She believes that Romney’s approach is better than Obama’s from an overall clinical perspective. “If you put all of the resources into checking blood pressure and free contraceptives and telling patients not to smoke, it takes resources away from taking care of people who are old and sick.”

More Freedom to Negotiate Fees

Conservative doctors believe that Romney also would give doctors greater freedom to negotiate fees with insurers and patients and get out from under government-set prices, along the lines of Medicare private contracting legislation introduced by Republican lawmakers. That’s because Romney says that he would encourage the growth of health insurance plans that put more financial responsibility on consumers, including high-deductible health savings account (HSA) plans.

“Romney’s general attitude is that he’s a free-market businessman and that if you bring free-market principles back to medicine, it will be good for everyone, including doctors and patients,” Dr. Sewell says.

Dr. Orient argues that Romney’s proposals would create a virtuous cycle that would help physicians in smaller practices remain independent. Giving consumers a tax deduction for buying individually owned insurance, allowing out-of-state sales of health insurance policies without state-mandated benefits, and encouraging high-deductible policies all would boost smaller insurers. In turn, independent doctors would have greater negotiating power with those insurers than with larger insurers. In contrast, she says, under Obamacare, independent doctors are “targeted for extinction.”

Dr. Atlas argues that the greater competition between insurers will lower premiums and lead to more Americans having insurance — even without the ACA’s refundable tax credits to help people afford coverage, which he calls a “fantasy handout.” Romney’s plan “reduces prices; more people will have insurance, and that’s good for doctors,” he says.

Hopefully an Improvement in the Malpractice Madness

Even physicians leaning toward Obama say that Romney’s approach toward medical liability is better for doctors. Romney has proposed a federal cap on noneconomic damages in malpractice lawsuits — a change long sought by organized medicine — along with alternative dispute resolution of malpractice cases.

“The Affordable Care Act falls way short of what’s needed on medical liability. It just kicks the can down the road, and the problem needs to be fixed,” says Mario Motta, MD, a Salem, Massachusetts, cardiologist and member of the AMA House of Delegates who generally supports Obama’s healthcare policies.

Dr. Robert Sewell strongly favors Romney’s damage cap proposal, which his state, Texas, passed in 2003. He says that the Texas cap has resulted in fewer “frivolous” lawsuits, a sharp decline in liability premiums, and an influx of doctors into the state — though he acknowledges that it still hasn’t reduced defensive medicine or overall healthcare costs. “What’s driving up the cost of care is defensive medicine, but [the impact of the cap] hasn’t filtered into the real world yet,” he says.

Doctors who back Romney also say that their candidate’s Medicare and Medicaid proposals would help doctors and patients by preserving the fiscal solvency of those programs. Romney wants to turn Medicare into a defined-contribution program in which seniors receive a fixed amount and pick either a private health plan or traditional Medicare. On Medicaid, he would give states a capped block grant and let them run the program with greater flexibility. Dr. Atlas believes that moving more Medicare patients into private health plans would boost payments to doctors and give patients better access to care. “Romney’s plan would save Medicare and Medicaid,” he says.

A Better Philosophical Fit

Overall, conservative physicians simply find Mitt Romney’s philosophical approach a better fit with their own personal and professional worldview. They see themselves as independent physicians and entrepreneurs, and they prefer Romney’s vision of expanding free-market medicine over President Obama’s model of competition within a more regulated framework.

“I think Romney’s platform is right: It’s short and it’s nonintrusive,” Dr. Sewell says. In contrast, he believes that Obama’s approach will “make us into employees of the government. I didn’t go to medical school, do a surgical residency, and spend 30 years in practice to become a government employee. I’ll retire before I allow that to happen.”

Retrieved from: http://www.medscape.com/viewarticle/773048_2

Why Obama Would Be Good For Doctors

Harris Meyer

Introduction

Re-electing President Barack Obama and continuing his policies would be better for physicians because millions more Americans will have insurance and be able to pay for healthcare and preventive services, say many physicians who support Obama. Additionally, administrative costs and hassles of dealing with insurers will be reduced, and doctors will play a leading role in new delivery systems to improve care and reduce costs.

Many physician Obama supporters also believe that Obama’s economic and tax policies are better for doctors overall — even if some doctors have to pay higher income taxes — because those policies will help build a society with a stronger middle class and fewer social problems. And they believe that he would protect public investments in medical research and public health while Mitt Romney’s budget plan might slash such spending.

Physicians who back Obama base their support largely on his comprehensive healthcare reform law, the Affordable Care Act (ACA). Although some would have preferred a single-payer, Medicare-for-all model, they say that the ACA finally will move the nation forward in addressing the longstanding problems of lack of healthcare coverage and access, rising costs, quality-of-care gaps, and poorer population health than in other advanced countries.

Like it or not, they say, there’s no way to ensure that Americans with preexisting medical conditions can get private insurance without the controversial ACA provision requiring nearly everyone to have insurance, just as there’s no way to make insurance affordable to lower-income people without the ACA’s subsidies.

“I firmly believe what’s best for physicians is getting everyone insured,” says Mario Motta, MD, a Salem, Massachusetts, cardiologist who’s a member of the American Medical Association House of Delegates. “Whatever person or party gets us to universal healthcare, that’s who I have to support because that’s what’s best in the long run.” He believes that the ACA’s private insurance expansion is the only way to avoid a “complete government takeover” of health insurance, which he opposes.

In contrast, Mitt Romney’s proposals to repeal the ACA and deregulate health insurance would sharply increase the number of uninsured and put even greater financial pressure on physicians. A recent Commonwealth Fund study[1] projects that the number of uninsured Americans under Romney’s proposals would soar to 72 million by 2022, while dropping to 27 million under Obama’s ACA law. Among nonelderly Americans, 22% would be uninsured in 2022 under Romney’s plan, compared with 10% under Obama’s law.

Taking Care of Ill Patients

Many pro-Obama physicians were appalled at Romney’s recent comments that uninsured Americans can always get care in the hospital emergency room and that “we don’t have people that become ill, who die in their apartment because they don’t have insurance.”

“It’s really hard to take care of patients when they can’t afford their pills or their treatment plan; they delay care until they have to go to the ER, and they skip doctor visits,” Dr. Motta says. “All of that is directly attributable to the fact that they don’t have insurance. We’ve pretty much solved that in Massachusetts.”

He leans toward Obama but appreciates the Massachusetts coverage expansion law that Romney as governor helped pass, which was the model for the ACA. He’s greatly disappointed that Romney has distanced himself from the Massachusetts reform model.

“The president’s health plan is certainly better for doctors than having 72 million people without health insurance,” agrees Rep. Jim McDermott, MD (D-Wash), a psychiatrist who represents the Seattle area and is a longtime sponsor of Medicare-for-all legislation. “It makes it possible for another 30 million people to have insurance and get preventive care. Doctors don’t want to just treat catastrophes; they want to help people be well. That’s a major step forward. Romney’s alternative is a disaster.”

Controlling Costs vs Free Market

Doctors who back Obama believe that the president’s regulated-market reform model stands a better chance of controlling costs and preserving smaller physician practices than Romney’s deregulated, free-market approach. They note that under the current competitive system, large hospital systems and insurers already are squeezing out independent doctors. And they contend that healthcare can never be a normal market because people don’t have enough information to shop for plans and providers, and sick people aren’t in a position to shop around.

Obama’s reform law establishes a regulated competition system for private insurers who, starting in 2014, will sell standardized benefit plans to individuals and small groups through new state health insurance exchanges. Insurers will have to accept all applicants regardless of preexisting conditions, with limited price variations based on age. In contrast, Romney wants to encourage more insurers to compete and offer a wide range of benefit packages, without having to meet state benefit mandates or accept applicants who haven’t had continuous coverage.

“The insurance exchange is good for doctors because then you’ve got a couple of health plans people will buy, and that cuts down on doctors’ back-office work,” Dr. McDermott says. “It’s a big drag on your office to have to take care of 25 different insurance firms and have all this paperwork. Doctors just want to take care of their patients and get paid.”

Independent Doctors

Other Obama supporters note that the current free-market model is hurting independent doctors who lack bargaining leverage, with many opting to work for hospital systems and larger groups. “Left on its own, the market will kill small private practice, no matter what doctors want to believe,” says Robert Berenson, MD, a general internist and health policy fellow at the Urban Institute in Washington, DC.

In contrast, he points to the Accountable Care Organization (ACO) demonstrations launched under the ACA, which lets groups of private physicians band together to streamline care for beneficiaries in traditional Medicare and share in any cost savings if they meet quality targets. Many ACOs have been started by physician-led groups without hospital involvement.

“The ACA set up tests of alternative payment approaches that put doctors back in control of their fate,” Dr. Berenson says. “So I think the law provides promise of a better healthcare system in which doctors will have greater satisfaction in their practice.”

Obama’s approach to Medicare and Medicaid is also better for doctors, Obama supporters argue, because he will preserve the programs as guaranteed benefits, providing patients with certainty that they’ll have access to care when they need it. In addition, his reform law enhanced Medicare’s preventive and drug coverage and extended the solvency of the program. In contrast, Romney’s Medicare voucher proposal means that people “don’t know whether they’ll have access to affordable care when they are old and sick,” says Steve Kagen, MD, an Appleton, Wisconsin, allergist and former Democratic congressman who’s proud of his vote for the ACA, which he calls the most important legislation in a century.

Similarly, he adds, Romney’s Medicaid block grant plan would “allow states to turn their back on people in need. What kind of nation would we be if we turned our back on children who are ill? By not paying providers their overhead for taking care of people in need, you’re turning your back on the community and on providers delivering lifesaving care.”

Effect on Society Beyond Doctors

More broadly, physicians who support Obama feel that his economic policies are better for all Americans, and that’s good for doctors. “As doctors, we’re dependent on a successful middle class, and our best opportunity is expanding the middle class,” Dr. Kagen says. “In my view, Obama has the best plan to expand the middle class, by investing in education, clean energy, and infrastructure. Then I’ll do better.”

Dr. Berenson adds that even though physicians might benefit financially from Romney’s proposals to cut taxes for wealthier Americans, “they wouldn’t be very happy with a society marked by increasing disparities between the rich and poor, more crime, and more demands on public funding for food and shelter. That’s not a world I want to live in.”

Regardless of their tax bills, he says that doctors’ professional interests lie more with Obama and the Democrats because “at least Democrats are trying to do something about the obvious problems in the healthcare system, while I’ve seen no evidence that Romney and the Republicans have any views of what should happen. Romney passed a very good law in Massachusetts, he’s proud of it, but he can’t tell anyone because his party is so Neanderthal on the issue.”

The bottom line is that doctors who back President Obama strongly prefer his focus on ensuring that all Americans have access to healthcare and a way to pay for it. “I assume doctors mostly go into the profession because they want the personal satisfaction of improving the health of the public,” Dr. Berenson says. “The obvious benefit of Obama’s law is that it sets up an environment where doctors can feel proud that they are working in the health system.”

Retrieved from: http://www.medscape.com/viewarticle/773050?src=mp

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